牙周再生治疗现状和进展
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摘要
牙周炎是人类最常见的口腔疾病,严重影响口颌系统功能,是成年人失牙的最主要原因。此外,作为长期持续性感染源,牙周炎还可引发人体慢性炎症和免疫反应,对全身系统性健康也有着重要影响。传统牙周炎治疗聚焦炎症控制,虽可阻止或延缓疾病进程,却难以获得满意的牙周病损组织再生。随着引导组织再生术、骨移植术、生长因子和生物材料等新技术、新材料引入牙周炎治疗,牙周组织再生的方法愈加丰富,临床效果也得到极大提高。展望未来,干细胞移植、内源性再生策略有望成为牙周病损组织生理性、功能性再生的重要方法。本文从以上方面对牙周组织再生的基础研究和临床应用现状简要回顾,并对未来该领域的发展前景和机遇进行展望。
Periodontitis is the most common oral disease and has a high incidence in humans.Periodontitis seriously affects the function of the oral and maxillofacial systems and is the most important cause of tooth loss in adults.In addition,as a long-term and persistent source of infection,periodontitis can not only trigger chronic inflammation and immune responses but also has an important impact on systemic health.Traditional periodontitis treatment focuses on inflammation control,and although this can prevent or delay the progression of the disease,satisfactory periodontal lesion tissue regeneration is difficult to obtain.With the introduction of new technologies and new materials such as guided tissue regeneration,bone grafting,growth factors and biological materials for the treatment of periodontitis,the method of periodontal tissue regeneration is more abundant,and the clinical effect has been greatly improved.In the future,stem cell transplantation and endogenous regeneration strategies are expected to become important methods for physiological and functional regeneration of periodontal lesions.This article briefly reviews the basic research and clinical application of periodontal tissue regeneration and forecasts the future development prospects and opportunities in this field.
Periodontitis is the most common oral disease and has a high incidence in humans.Periodontitis seriously affects the function of the oral and maxillofacial systems and is the most important cause of tooth loss in adults.In addition,as a long-term and persistent source of infection,periodontitis can not only trigger chronic inflammation and immune responses but also has an important impact on systemic health.Traditional periodontitis treatment focuses on inflammation control,and although this can prevent or delay the progression of the disease,satisfactory periodontal lesion tissue regeneration is difficult to obtain.With the introduction of new technologies and new materials such as guided tissue regeneration,bone grafting,growth factors and biological materials for the treatment of periodontitis,the method of periodontal tissue regeneration is more abundant,and the clinical effect has been greatly improved.In the future,stem cell transplantation and endogenous regeneration strategies are expected to become important methods for physiological and functional regeneration of periodontal lesions.This article briefly reviews the basic research and clinical application of periodontal tissue regeneration and forecasts the future development prospects and opportunities in this field.
引文
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[3] Larsson L, Decker AM, Nibali L, et al. Regenerative medicine for periodontal and peri-implant diseases[J]. J Dent Res, 2016, 95(3):255-266.
[4] Kuang YC, Hu B, Chen J, et al. Effects of periodontal endoscopy on the treatment of periodontitis:a systematic review and metaanalysis[J]. J Am Dent Assoc, 2017, 148(10):750-759.
[5] Orekhova LY, Neizberg DM, Demchenko TV, et al. Prospects of endoscopic technology for diagnostics of inflammatory periodontal disease[J]. Stomatologiia(Mosk), 2016, 95(5):4-7.
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[30] Roselló-Campsà, Monje A, Lin GH, et al. Platelet-rich plasma for periodontal regeneration in the treatment of intrabony defects:a meta-analysis on prospective clinical trials[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015, 120(5):562-574.
[31] Saleem M, Pisani F, Zahid FM, et al. Adjunctive platelet-rich plasma(PRP)in infrabony regenerative treatment:a systematic review and RCT′s meta-analysis[J]. Stem Cells Int, 2018:9594235.
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[33] Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet-rich fibrin in regenerative dentistry:a systematic review[J]. Clin Oral Investig, 2017, 21(6):1913-1927.
[34] Qiao J, Duan J, Zhang Y, et al. The effect of concentrated growth factors in the treatment of periodontal intrabony defects[J]. Future science OA, 2016, 2(4):FS136.
[35] Bartold PM, Mcculloch CA, Narayanan AS, et al. Tissue engineering:a new paradigm for periodontal regeneration based on molecular and cell biology[J]. Periodontol 2000, 2000, 24(1):253-269.
[36] Ashri NY, Ajlan SA, Aldahmash AM. Dental pulp stem cells biology and use for periodontal tissue engineering[J]. Saudi Med J,2015, 36(12):1391-1399.
[37] Bright R, Hynes K, Gronthos S, et al. Periodontal ligament-derived cells for periodontal regeneration in animal models:a systematic review[J]. J Periodontal Res, 2015, 50(2):160-172.
[38] Khorsand A, Eslaminejad MB, Arabsolghar M, et al. Autologous dental pulp stem cells in regeneration of defect created in canine periodontal tissue[J]. J Oral Implantol, 2013, 39(4):433-443.
[39] Hu JC, Cao Y, Xie YL, et al. Periodontal regeneration in swine after cell injection and cell sheet transplantation of human dental pulp stem cells following good manufacturing practice[J]. Stem Cell Res Ther, 2016, 7(1):130.
[40] Aimetti M, Ferrarotti F, Cricenti L, et al. Autologous dental pulp stem cells in periodontal regeneration:a case report[J]. Int J Periodont Restor Dent, 2014, 34(Suppl):S27-S33.
[41] Tomasello L, Mauceri R, Coppola A, et al. Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue:a potential application for bone formation[J]. Stem Cell Res Ther,2017, 8(1):179.
[42] Li Y, Zhao SM, Nan X, et al. Repair of human periodontal bone defects by autologous grafting stem cells derived from inflammatory dental pulp tissues[J]. Stem Cell Res Ther, 2016, 7(1):141.
[43] Fu XR, Jin LY, Ma P, et al. Allogeneic stem cells from deciduous teeth in treatment for periodontitis in miniature swine[J]. J Periodontol, 2014, 85(6):845-851.
[44] Du J, Shan Z, Ma P, et al. Allogeneic bone marrow mesenchymal stem cell transplantation for periodontal regeneration[J]. J Dent Res, 2014, 93(2):183-188.
[45] Tobita M, Mizuno H. Adipose-derived stem cells and periodontal tissue engineering[J]. Int J Oral Maxillofac Implants, 2013, 28(6):e487-e493.
[46] Requicha JF, Viegas CA, Munoz F, et al. A tissue engineering approach for periodontal regeneration based on a biodegradable double-layer scaffold and adipose-derived stem cells[J]. Tissue Eng Part A, 2014, 20(17/18):2483-2492.
[47] Han J, Menicanin D, Marino V, et al. Assessment of the regenerative potential of allogeneic periodontal ligament stem cells in a rodent periodontal defect model[J]. J Periodontal Res, 2014, 49(3):333-345.
[48] Ding G, Liu Y, Wang W, et al. Allogeneic periodontal ligament stem cell therapy for periodontitis in swine[J]. Stem Cells, 2010, 28(10):1829-1838.
[49] Liu Y, Zheng Y, Ding G, et al. Periodontal ligament stem cell-mediated treatment for periodontitis in miniature swine[J]. Stem Cells, 2008, 26(4):1065-1073.
[50] Mrozik KM, Wada N, Marino VA, et al. Regeneration of periodontal tissues using allogenic periodontal ligament stem cells in an ovine model[J]. Regen Med, 2013, 8(6):711-723.
[51] Ding G, Wang W, Liu Y, et al. Effect of cryopreservation on biological and immunological properties of stem cells from apical papilla[J]. J Cell Physiol, 2010, 223(2):415-422.
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[2] Chen FM, Zhang J, Zhang M, et al. A review on endogenous regenerative technology in periodontal regenerative medicine[J]. Biomaterials, 2010, 31(31):7892-7927.
[3] Larsson L, Decker AM, Nibali L, et al. Regenerative medicine for periodontal and peri-implant diseases[J]. J Dent Res, 2016, 95(3):255-266.
[4] Kuang YC, Hu B, Chen J, et al. Effects of periodontal endoscopy on the treatment of periodontitis:a systematic review and metaanalysis[J]. J Am Dent Assoc, 2017, 148(10):750-759.
[5] Orekhova LY, Neizberg DM, Demchenko TV, et al. Prospects of endoscopic technology for diagnostics of inflammatory periodontal disease[J]. Stomatologiia(Mosk), 2016, 95(5):4-7.
[6] Bundidpun P, Srisuwantha R, Laosrisin N. Clinical effects of photodynamic therapy as an adjunct to full-mouth ultrasonic scaling and root planing in treatment of chronic periodontitis[J]. Laser Ther, 2018, 27(1):33-39.
[7] Mopur JM, Devi TR, Ali SM, et al. Clinical and radiographic evaluation of regenerative potential of GTR membrane(Biomesh?)along with alloplastic bone graft(Biograft?)in the treatment of periodontal intrabony defects[J]. J Contemp Dent Pract, 2013, 14(3):434-439.
[8] Keles GC, Sumer M, Cetinkaya B, et al. Effect of autogenous cortical bone grafting in conjunction with guided tissue regeneration in the treatment of intraosseous periodontal defects[J]. Eur J Dent,2010, 4(4):403-411.
[9] Sculean A, Nikolidakis D, Nikou G, et al. Biomaterials for promoting periodontal regeneration in human intrabony defects:a systematic review[J]. Periodontol 2000, 2015, 68(1):182-216.
[10] Palachur D, Prabhakara RK, Murthy KR, et al. A comparative evaluation of bovine-derived xenograft(Bio-Oss Collagen)and type I collagen membrane(Bio-Gide)with bovine-derived xenograft(Bio-Oss Collagen)and fibrin fibronectin sealing system(TISSEEL)in the treatment of intrabony defects:a clinico-radiographic study[J]. J Indian Soc Periodontol, 2014, 18(3):336-343.
[11] Heberer S, Al-Chawaf B, Hildebrand DA, et al. Histomorphometric analysis of extraction sockets augmented with Bio-Oss collagen after a 6-week healing period:a prospective study[J]. Clin Oral Implants Res, 2008, 19(12):1219-1225.
[12] Oortgiesen DA, Plachokova AS, Geenen C, et al. Alkaline phosphatase immobilization onto Bio-Gide(R)and Bio-Oss(R)for periodontal and bone regeneration[J]. J Clin Periodontol, 2012, 39(6):546-555.
[13] Nagayasu-Tanaka T, Anzai J, Takaki S, et al. Action mechanism of fibroblast growth factor-2(FGF-2)in the promotion of periodontal regeneration in Beagle dogs[J]. PLoS One, 2015, 10(6):e0131870.
[14] Cao Y, Liu ZH, Xie YL, et al. Adenovirus-mediated transfer of hepatocyte growth factor gene to human dental pulp stem cells under good manufacturing practice improves their potential for periodontal regeneration in swine[J]. Stem Cell Res Ther, 2015, 6:249.
[15] Lee J, Wikesj?UM. Growth/differentiation factor-5:pre-clinical and clinical evaluations of periodontal regeneration and alveolar augmentation--review[J]. J Clin Periodontol, 2014, 41(8):797-805.
[16] Li FF, Yu FY, Xu X, et al. Evaluation of recombinant human FGF-2 and PDGF-BB in periodontal regeneration:a systematic review and Meta-analysis[J]. Sci Rep, 2017, 7(1):65.
[17] Lo KW, Ulery BD, Ashe KM, et al. Studies of bone morphogenetic protein-based surgical repair[J]. Adv Drug Deliv Rev, 2012, 64(12):1277-1291.
[18] Calin C, Patrascu I. Growth factors and beta-tricalcium phosphate in the treatment of periodontal intraosseous defects:a systematic review and meta-analysis of randomised controlled trials[J]. Arch Oral Biol, 2016, 66:44-54.
[19] Geiger M, Li RH, Friess W. Collagen sponges for bone regeneration with rhBMP-2[J]. Adv Drug Deliv Rev, 2003, 55(12):1613-1629.
[20] Hammarstr?m L. Enamel matrix, cementum development and regeneration[J]. J Clin Periodontol, 1997, 24(9):658-668.
[21] Miron RJ, Sculean A, Cochran DL, et al. Twenty years of enamel matrix derivative:the past, the present and the future[J]. J Clin Periodontol, 2016, 43(8):668-683.
[22] Apicella A, Heunemann P, Dejace LA, et al. Scaffold requirements for periodontal regeneration with enamel matrix derivative proteins[J]. Colloids Surf B Biointerfaces, 2017, 156:221-226.
[23] Ghezzi C, Ferrantino L, Bernardini L, et al. Minimally invasive surgical technique in periodontal regeneration:a randomized controlled clinical trial pilot study[J]. Int J Periodontics Restorative Dent, 2016, 36(4):475-482.
[24] Matarasso M, Iorio-Siciliano V, Blasi A, et al. Enamel matrix derivative and bone grafts for periodontal regeneration of intrabony defects. A systematic review and meta-analysis[J]. Clin Oral Investig, 2015, 19(7):1581-1593.
[25] Viana Casarin RC, Ribeiro ED, Nociti J, et al. Enamel matrix derivative proteins for the treatment of proximal classⅡfurcation involvements:a prospective 24-month randomized clinical trial[J]. J Clin Periodontol, 2010, 37(12):1100-1109.
[26] Alexiou A, Vouros I, Menexes GA. Comparison of enamel matrix derivative(Emdogain)and subepithelial connective tissue graft for root coverage in patients with multiple gingival recession defects:a randomized controlled clinical study[J]. Quintessence Int(Berl),2017, 48(5):381-389.
[27] Rodella LF, Favero G, Boninsegna R, et al. Growth factors, CD34positive cells, and fibrin network analysis in concentrated growth factors fraction[J]. Microsc Res Tech, 2011, 74(8):772-777.
[28] Masuki H, Okudera T, Watanebe T, et al. Growth factor and proinflammatory cytokine contents in platelet-rich plasma(PRP),plasma rich in growth factors(PRGF), advanced platelet-rich fibrin(A-PRF), and concentrated growth factors(CGF)[J]. Int J Implant Dent, 2016, 2(1):19.
[29] Plachokova AS, Nikolidakis D, Mulder JA, et al. Effect of plateletrich plasma on bone regeneration in dentistry:a systematic review[J]. Clin Oral Implants Res, 2008, 19(6):539-545.
[30] Roselló-Campsà, Monje A, Lin GH, et al. Platelet-rich plasma for periodontal regeneration in the treatment of intrabony defects:a meta-analysis on prospective clinical trials[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2015, 120(5):562-574.
[31] Saleem M, Pisani F, Zahid FM, et al. Adjunctive platelet-rich plasma(PRP)in infrabony regenerative treatment:a systematic review and RCT′s meta-analysis[J]. Stem Cells Int, 2018:9594235.
[32] Thorat MK, Baghele ON, Rakhewar PS. Adjunctive effect of autologous platelet-rich fibrin in the treatment of intrabony defects in localized aggressive periodontitis patients:a randomized controlled split-mouth clinical trial[J]. Int J Periodont Restor Dent,2017, 37(6):302-309.
[33] Miron RJ, Zucchelli G, Pikos MA, et al. Use of platelet-rich fibrin in regenerative dentistry:a systematic review[J]. Clin Oral Investig, 2017, 21(6):1913-1927.
[34] Qiao J, Duan J, Zhang Y, et al. The effect of concentrated growth factors in the treatment of periodontal intrabony defects[J]. Future science OA, 2016, 2(4):FS136.
[35] Bartold PM, Mcculloch CA, Narayanan AS, et al. Tissue engineering:a new paradigm for periodontal regeneration based on molecular and cell biology[J]. Periodontol 2000, 2000, 24(1):253-269.
[36] Ashri NY, Ajlan SA, Aldahmash AM. Dental pulp stem cells biology and use for periodontal tissue engineering[J]. Saudi Med J,2015, 36(12):1391-1399.
[37] Bright R, Hynes K, Gronthos S, et al. Periodontal ligament-derived cells for periodontal regeneration in animal models:a systematic review[J]. J Periodontal Res, 2015, 50(2):160-172.
[38] Khorsand A, Eslaminejad MB, Arabsolghar M, et al. Autologous dental pulp stem cells in regeneration of defect created in canine periodontal tissue[J]. J Oral Implantol, 2013, 39(4):433-443.
[39] Hu JC, Cao Y, Xie YL, et al. Periodontal regeneration in swine after cell injection and cell sheet transplantation of human dental pulp stem cells following good manufacturing practice[J]. Stem Cell Res Ther, 2016, 7(1):130.
[40] Aimetti M, Ferrarotti F, Cricenti L, et al. Autologous dental pulp stem cells in periodontal regeneration:a case report[J]. Int J Periodont Restor Dent, 2014, 34(Suppl):S27-S33.
[41] Tomasello L, Mauceri R, Coppola A, et al. Mesenchymal stem cells derived from inflamed dental pulpal and gingival tissue:a potential application for bone formation[J]. Stem Cell Res Ther,2017, 8(1):179.
[42] Li Y, Zhao SM, Nan X, et al. Repair of human periodontal bone defects by autologous grafting stem cells derived from inflammatory dental pulp tissues[J]. Stem Cell Res Ther, 2016, 7(1):141.
[43] Fu XR, Jin LY, Ma P, et al. Allogeneic stem cells from deciduous teeth in treatment for periodontitis in miniature swine[J]. J Periodontol, 2014, 85(6):845-851.
[44] Du J, Shan Z, Ma P, et al. Allogeneic bone marrow mesenchymal stem cell transplantation for periodontal regeneration[J]. J Dent Res, 2014, 93(2):183-188.
[45] Tobita M, Mizuno H. Adipose-derived stem cells and periodontal tissue engineering[J]. Int J Oral Maxillofac Implants, 2013, 28(6):e487-e493.
[46] Requicha JF, Viegas CA, Munoz F, et al. A tissue engineering approach for periodontal regeneration based on a biodegradable double-layer scaffold and adipose-derived stem cells[J]. Tissue Eng Part A, 2014, 20(17/18):2483-2492.
[47] Han J, Menicanin D, Marino V, et al. Assessment of the regenerative potential of allogeneic periodontal ligament stem cells in a rodent periodontal defect model[J]. J Periodontal Res, 2014, 49(3):333-345.
[48] Ding G, Liu Y, Wang W, et al. Allogeneic periodontal ligament stem cell therapy for periodontitis in swine[J]. Stem Cells, 2010, 28(10):1829-1838.
[49] Liu Y, Zheng Y, Ding G, et al. Periodontal ligament stem cell-mediated treatment for periodontitis in miniature swine[J]. Stem Cells, 2008, 26(4):1065-1073.
[50] Mrozik KM, Wada N, Marino VA, et al. Regeneration of periodontal tissues using allogenic periodontal ligament stem cells in an ovine model[J]. Regen Med, 2013, 8(6):711-723.
[51] Ding G, Wang W, Liu Y, et al. Effect of cryopreservation on biological and immunological properties of stem cells from apical papilla[J]. J Cell Physiol, 2010, 223(2):415-422.
[52] Liu OS, Xu JJ, Ding G, et al. Periodontal ligament stem cells regulate B lymphocyte function via programmed cell death protein 1[J].Stem Cells, 2013, 31(7):1371-1382.
[53] Kinnaird T, Stabile E, Burnett MS, et al. Local delivery of marrowderived stromal cells augments collateral perfusion through paracrine mechanisms[J]. Circulation, 2004, 109(12):1543-1549.
[54] Baik HS, Park J, Lee KJ, et al. Local application of periodontal ligament stromal cells promotes soft tissue regeneration[J]. Oral Dis,2014, 20(6):574-581.
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